Challenges Addressing Lung Cancer Screening for Patients With Multimorbidity in Primary Care: A Qualitative Study.

PURPOSE: Many individuals who are eligible for lung cancer screening have comorbid conditions complicating their shared decision-making conversations with physicians. The goal of our study was to better understand how primary care physicians (PCPs) factor comorbidities into their evaluation of the risks and benefits of lung cancer screening and into their shared decision-making conversations with patients. METHODS: We conducted semistructured interviews by videoconference with 15 PCPs to assess the extent of shared decision-making practices and explore their understanding of the intersection of comorbidities and lung cancer screening, and how that understanding informed their clinical approach to this population. RESULTS: We identified 3 themes. The first theme was whether to discuss or not to discuss lung cancer screening. PCPs described taking additional steps for individuals with complex comorbidities to decide whether to initiate this discussion and used subjective clinical judgment to decide whether the conversation would be productive and beneficial. PCPs made mental assessments that factored in the patient's health, life expectancy, quality of life, and access to support systems. The second theme was that shared decision making is not a simple discussion. When PCPs did initiate discussions about lung cancer screening, although some believed they could provide objective information, others struggled with personal biases. The third theme was that ultimately, the decision to be screened was up to the patient. Patients had the final say, even if their decision was discordant with the PCP's advice. CONCLUSIONS: Shared decision-making conversations about lung cancer screening differed substantially from the standard for patients with complex comorbidities. Future research should include efforts to characterize the risks and benefits of LCS in patients with comorbidities to inform guidelines and clinical application.

Co-occurring psychological distress and alcohol or other drug use among Indigenous Australians: Data from the National Aboriginal and Torres Strait Islander Health Survey.

OBJECTIVES: To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older. METHODS: This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia. RESULTS: A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions. CONCLUSION: A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions.

Advanced Data Processing of Pancreatic Cancer Data Integrating Ontologies and Machine Learning Techniques to Create Holistic Health Records.

The modern healthcare landscape is overwhelmed by data derived from heterogeneous IoT data sources and Electronic Health Record (EHR) systems. Based on the advancements in data science and Machine Learning (ML), an improved ability to integrate and process the so-called primary and secondary data fosters the provision of real-time and personalized decisions. In that direction, an innovative mechanism for processing and integrating health-related data is introduced in this article. It describes the details of the mechanism and its internal subcomponents and workflows, together with the results from its utilization, validation, and evaluation in a real-world scenario. It also highlights the potential derived from the integration of primary and secondary data into Holistic Health Records (HHRs) and from the utilization of advanced ML-based and Semantic Web techniques to improve the quality, reliability, and interoperability of the examined data. The viability of this approach is evaluated through heterogeneous healthcare datasets pertaining to personalized risk identification and monitoring related to pancreatic cancer. The key outcomes and innovations of this mechanism are the introduction of the HHRs, which facilitate the capturing of all health determinants in a harmonized way, and a holistic data ingestion mechanism for advanced data processing and analysis.

The interplay of spiritual health, resilience, and happiness: an evaluation among a group of dental students at a state university in Turkey.

BACKGROUND: Dental education is one of the disciplines where students are most significantly affected psychologically. The aim of this study was to evaluate the relationship between spiritual health, resilience and happiness levels of dental students at a state university in Turkey. METHODS: This cross- sectional study included 212 students from the 3rd, 4th and 5th grades of the faculty of dentistry. A questionnaire consisting of 4 sections was used in the study. The sections of the questionnaire include students' general and academic information, Turkish adaptations of the Spiritual Well-Being Scale, The Brief Resilience Scale, and the Oxford Happiness Questionnaire-Short Form. Data analysis was performed with IBM SPSS 25 package program. The Shapiro-Wilk test was used to assess the normal distribution of the data. The Mann-Whitney U test was preferred for comparisons between two categorical variables and one numerical variable. The Kruskal-Wallis H test was employed for comparisons involving two categorical variables and one numerical variable. The presence of a relationship between two numerical variables was examined using the Spearman test. RESULTS: In terms of resilience and happiness scores, males had higher scores than females. It was determined that third graders scored higher than fifth graders in harmony with nature scores, and third graders scored higher than fourth graders in deregulation scores. There was a positive correlation between happiness, spiritual well-being and resilience; a negative correlation between happiness and anomie. There was no significant relationship between age and happiness scores. As a result of multiple linear regression to determine the factors affecting happiness; increases in spiritual well-being and resilience will lead to an increase in happiness levels. CONCLUSION: This study concluded that increased levels of spiritual well-being and resilience among a group of dental students would lead to increased levels of happiness. However, further research is needed to understand the relationship between mental health, resilience and happiness levels during dental education.

The concept of holism applied in recent palliative care practice: A scoping review.

BACKGROUND: Whilst there is a sense of holism existing within palliative care practice, what is not clear is the extent to which holism, as applied in recent palliative care practice, has been adequately researched. Currently, no reviews on this topic were identified through systematic and scoping review registries. AIM: To identify and describe the available published evidence on the key features of holism and the core domains underpinning the application of holism in relation to recent palliative care practice. DESIGN: Scoping review using the Johanna Briggs Institute design. DATA SOURCES: MEDLINE, EMCARE, and CINAHL (Ovid), PsycINFO, SocINDEX, SCOPUS and Web of Science. (International, peer-reviewed, published papers in the English language from January 2010to December 2020). RESULTS: Five studies met inclusion criteria. Two studies used qualitative methods, one used mixed-methods, and two were randomised controlled trials. The research investigated (1) frameworks for holistic care and (2) assessment tools applied in palliative care settings. CONCLUSIONS: The results from the review led to identifying key features of palliative care that were presented as interconnected aspects of holistic care domains in both assessments and interventions. The literature revealed a focus on curative and biomedical approaches to disease management with holistic aspects acknowledged, but not in the forefront of core service delivery. Holism was generally conceptualised as an overarching theoretical framework to palliative care service provision and positioned as an adjunct to palliative models of care. These findings point to a gap in research that links the concept of holism to applied palliative care practices.

Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention.

BACKGROUND: Spiritual needs gain importance in old age but are often ignored in health care. Within the 'Holistic care program for elderly patients to integrate spiritual needs, social activity and self-care into disease management in primary care (HoPES3)' a complex intervention was evaluated in a cluster-randomized trial. The aim of this study was to explore the acceptability, feasibility, benefits, and harms of a spiritual history taken by general practitioners (GPs) as part of the complex intervention. METHODS: In this mixed-methods study telephone interviews with 11 German GPs and 12 medical assistants (MAs) of the HoPES3 intervention group were conducted and analysed using a content-analytical approach. Furthermore, GPs were asked to complete a questionnaire after each spiritual history. One hundred and forty-one questionnaires from 14 GPs were analysed descriptively. RESULTS: GPs considered the spiritual history very/quite helpful for the patient in 27% (n= 38) and very/quite stressful in 2% (n = 3) of the cases. Interviews indicated that GPs found discussing spiritual history easier than anticipated. GPs and MAs saw a difficulty in that many patients associated spirituality with religion or church and reacted with surprise or rejection. Benefits for patients were seen in the opportunity to talk about non-medical topics, and increased awareness of their own resources. Benefits for GPs mainly related to information gain and an intensified patient-physician relationship. CONCLUSIONS: A spiritual history in general practice has the potential to reveal important information about patients' lives and to improve the patient-physician relationship. Implementation barriers identified in this study have to be considered and addressed.

Mapping a comprehensive assessment tool to a holistic definition of health for person-centred care planning in home care: a modified eDelphi study.

BACKGROUND: Researchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broadly encompassing health definition to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions. The PPH was subsequently converted to the My Positive Health (MPH) spider web visualization tool. This study sought to identify opportunities for more person-centred care planning at the point of care in home care, using the MPH tool as a framework to link comprehensive assessment and dialogue-based goal-setting. METHODS: A modified eDelphi method was used to conduct domain mapping with a purposively sampled expert panel (n = 25). The panel consisted of researchers, health care providers, older adults and caregivers. A two-stage eDelphi process was conducted, with each stage consisting of three survey rounds. In the first stage, participants were asked to map 201 elements of the interRAI Home Care (interRAI HC) comprehensive assessment tool to the six MPH domains or "No pillar of best fit". The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the MPH domains. RESULTS: In Stage 1, 189 of 201 elements reached consensus in domain mapping. These included: 80 elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, and 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in Stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in Meaningfulness and Participation and 11 additional descriptors across the six MPH domains. Of these, two elements and nine of the 11 descriptors reached consensus. CONCLUSION: Findings show that elements of the interRAI HC are oriented toward the physical, functional, and mental health domains. Consequently, complementary assessment elements and/or tools may be needed to support comprehensive assessment of 'Meaningfulness' and 'Participation' in person-centred home and community care. Additional descriptors may also be needed to aid communication regarding the understanding and application of MPH domains.

Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation.

BACKGROUND: There is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program-Employee Whole Health (EWH)-focused on the holistic needs of all employees. This evaluation's goal was to use the Lean Enterprise Transformation (LET) model for organizational transformation to identify key factors-facilitators and barriers-affecting the implementation of VA EWH. METHODS: This cross-sectional qualitative evaluation based on the action research model reflects on the organizational implementation of EWH. Semi-structured 60-minute phone interviews were conducted in February-April 2021 with 27 key informants (e.g., EWH coordinator, wellness/occupational health staff) knowledgeable about EWH implementation across 10 VA medical centers. Operational partner provided a list of potential participants, eligible because of their involvement in EWH implementation at their site. The interview guide was informed by the LET model. Interviews were recorded and professionally transcribed. Constant comparative review with a combination of a priori coding based on the model and emergent thematic analysis was used to identify themes from transcripts. Matrix analysis and rapid turnaround qualitative methods were used to identify cross-site factors to EWH implementation. RESULTS: Eight common factors in the conceptual model were found to facilitate and/or hinder EWH implementation efforts: [1] EWH initiatives, [2] multilevel leadership support, [3] alignment, [4] integration, [5] employee engagement, [6] communication, [7] staffing, and [8] culture. An emergent factor was [9] the impact of the COVID-19 pandemic on EWH implementation. CONCLUSIONS: As VA expands its EWH cultural transformation nationwide, evaluation findings can (a) enable existing programs to address known implementation barriers, and (b) inform new sites to capitalize on known facilitators, anticipate and address barriers, and leverage evaluation recommendations through concerted implementation at the organization, process, and employee levels to jump-start their EWH program implementation.

Fostering interdisciplinary colorectal and gynaecology surgery networks during training is crucial to maximise expertise and innovate patient care.

The importance of interdisciplinary collaboration between specialties has gained significant recognition in recent years, and rightly so with notable benefits to skills acquisition and patient outcomes. Due to the scope of overlapping procedures and clinical scenarios, developing trustable networks between colorectal and gynaecology surgeons must be encouraged as a focus of trainee education. This article highlights the benefits, challenges, and recommendations for fostering such networks.

The reliability, validity, and responsiveness of Cognitive Exercise Therapy Approach: Biopsychosocial Questionnaire for patients with psoriatic arthritis.

Although the importance of the biopsychosocial model that aims the optimum treatment is emphasized in the literature, there is a lack of scales that evaluate individuals with PsA in a multi-dimensional way, including all areas of influence. This study aimed to determine the validity, reliability, and responsiveness of the Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire (BETY-BQ) in individuals diagnosed with Psoriatic Arthritis (PsA). Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL), Health Assessment Questionnaire, Hospital Anxiety and Depression Scale, and Short Form-36 were used for the validity of the BETY-BQ. For scale reliability, the test-retest method was performed, Intraclass Correlation Coefficient (ICC) was calculated, and Cronbach's alpha (α) coefficient was checked for internal consistency. For the responsiveness of the scale, all scales were re-applied with 3 months intervals. The correlations of BETY-BQ with the other scales were found medium to very high. ICC was analyzed to compare the reliability of the test-retest results and it was found to be excellent. Cronbach's α value was found to be 0.940 which showed an excellent internal consistency. The time-dependent change sensitivity of BETY-BQ was found to be highly correlated with the PsA-specific scale, the PsAQoL questionnaire. BETY-BQ was determined as a valid, reliable, and sensitive assessment tool that health professionals can use in individuals with PsA diagnosis. In this study, a scale that will reveal the biopsychosocial responses of individuals with PsA to pharmacological and non-pharmacological treatments was presented to the literature.

Effectiveness of a Cognitive Behavioral Randomized Controlled Trial for People Living with HIV Who are Heavy Drinkers: The Holistic Health Recovery Program (HHRP) Trial in Miami.

This study evaluates the impact of an intervention targeting high-risk behaviors among diverse, alcohol-using adults living with HIV (N = 267) from 2009 to 2013 in Miami, FL. The intervention took place in a group setting for eight sessions over 4 weeks and was compared to a didactic health promotion group. Assessments were conducted pre-intervention, post-intervention, and at 3, 6, and 12 months follow-up. Intervention participants (48% of sample) evidenced greater knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms after participation. This was particularly noteworthy because associations among knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms were negatively associated with intervention status at baseline. Participants also reported fewer heavy drinking days after participating in the intervention than those in the control group. Greater HIV knowledge, more condom self-efficacy and intentions to use condoms predicted more condom assertiveness; greater intentions to use condoms predicted fewer unprotected sexual behaviors. These findings underscore the importance of taking a comprehensive, multi-systemic approach to address risky behaviors in high-risk, diverse populations.

Biopsychosocial Experiences of Elite Athletes Retiring From Sport for Career-Ending Injuries: A Critically Appraised Topic.

CLINICAL SCENARIO: Injuries cause individuals varying amounts of time loss from participation, which may depend on injury and sport-specific factors such as level of participation. Athletes who never return to sport either choose or are forced to retire due to numerous factors. At elite levels of play, when an athlete chooses retirement, they have the opportunity to create and execute a retirement plan; however, if unexpected (eg, due to career-ending injury), athletes may struggle to transition out of sport effectively, impacting physical, mental, and social health. The biopsychosocial model looks at the relationship between biology, psychology, and socio-environmental factors. Therefore, the purpose of this study was to better understand the biopsychosocial experiences elite athletes face after a career-ending injury so that sport stakeholders can develop and implement strategies to support a healthy transition. CLINICAL QUESTION: How does suffering a career-ending injury affect elite athletes' biopsychosocial experiences during retirement from sport? SUMMARY OF KEY FINDINGS: All studies found that a career-ending injury negatively impacted athlete's biopsychosocial health during the transition period. In addition, social support was identified as a positive coping mechanism and research highlighted the role of education in promoting successful transitions. Sport stakeholders should educate athletes regarding the importance of creating secondary plans. By creating a culture of athletic and nonathletic identity, athletes can feel empowered to navigate different phases of their life despite transition being forced upon them due to injury. CLINICAL BOTTOM LINE: Career-ending injuries negatively impact the biopsychosocial experiences of elite athletes as they transition out of sport. Athletes may face many transitional challenges including a loss of identity, a lack of external support, and/or mental health decline; those more closely identifying with their role as an athlete tend to have a harder transition. Therefore, it is important for all athletes to be adequately prepared for sport retirement, especially given the uncertainty about when and how retirement may occur. STRENGTH OF RECOMMENDATION: Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of C.

Role of the teenage and young adult blood and marrow stem-cell transplant clinical nurse specialist.

This article explores the role of the teenage and young adult (TYA) blood and marrow stem-cell transplant clinical nurse specialist (CNS) from the author's perspective, and the challenges of developing a novel role. The article aims to provide insight into the role, and review the benefits of the CNS to patient care, thus highlighting the value of developing such a role within other stem-cell transplant centres in the UK.

Posture correction as part of holistic health promotion in Hungarian schools.

The primary prevention program of the Hungarian Spine Society was launched in 1995 with two goals: 1. to achieve that all school-children take part regularly in effective posture correcting exercises as part of physical education; and 2. to achieve daily physical education for all school-children. With appropriate governmental legislation and parliamentary decision both goals were integrated into the National Public Health Program in 2001 and 2003 and later in the national educational laws and documents. From 2011 and 2012 holistic health promotion in schools with the goal to reach all children became also prescription for all schools in Hungary. Public health institutions and actors still have to do much: they have to give continuous professional help to the physical education teachers in their posture correcting work and to all teachers in their daily health promoting tasks. The article presents the details of the special posture correcting exercises, their distribution and prospective controlled studies, their place in the national education, the present situation and the further tasks. The article is supplemented by a short report about daily physical education and holistic health promotion in schools: how the prescription was achieved, the essence and the follow up of it, and what are the tasks for the helping public health actors.

Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial.

BACKGROUND: The prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice. METHODS: The purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral. DISCUSSION: Complex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity. TRIAL REGISTRATION: Implementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).

Mindfulness-based arts interventions for cancer care: A systematic review of the effects on wellbeing and fatigue.

OBJECTIVE: Upon receiving a cancer diagnosis, life irrevocably changes and complex experiences of emotional distress often occur. There is a growing interest in mindfulness-based arts interventions (MBAIs) to ameliorate the distress many patients experience. Our review objective was to synthesize the evidence on the effectiveness of MBAIs on psychological wellbeing and fatigue. METHOD: Relevant quantitative articles were identified through a systematic search of the grey literature and online databases including MEDLINE, CINAHL, Cochrane CENTRAL, Art Full Text, ART bibliographies Modern, PsycINFO, Scopus, and EMBASE. Two independent reviewers screened titles/abstracts against predetermined inclusion criteria, read full-text articles for eligibility, conducted quality appraisals of included articles, and extracted pertinent data with a standardized data extraction form. The heterogeneity of the included studies precluded a meta-analysis and a narrative synthesis of study outcomes was conducted. RESULTS: Our systematic search retrieved 4241 titles/abstracts, and 13 studies met our inclusion criteria (eight randomized controlled trials and five quasi-experiments). Most of the studies focused on patients with cancer (92.3%). There is a growing interest in MBAIs over time and significant heterogeneity in the types of interventions. A significant effect was found on several outcomes that are important in psychosocial oncology: quality of life, psychological state, spiritual wellbeing, and mindfulness. The effect on fatigue was equivocal. CONCLUSIONS: This novel intervention demonstrates promise for the psychosocial care of patients with cancer. These findings are an essential antecedent to the continued implementation, development, and evaluation of MBAIs in oncology.

Physiotherapy services in patient care in Bhutan.

Physiotherapy and rehabilitative services are an integral part of patient care, but in many developing countries they are not considered a priority and are either not available or not easily accessible to those who need them. Bhutan is one such country where healthcare is provided free of cost to all, but as of 2021 physiotherapy services were available only in 26 of 48 hospitals and 19 of 20 districts. The number of physiotherapy professionals per 10,000 population is 1.4 with significant rates of attrition. There is lack of awareness among patients and other health professionals about physiotherapy and rehabilitation services. The country needs to integrate physiotherapy and rehabilitation services into the overall health policy framework and develop proper planning of human resources and infrastructure to meet the current and future demands.

A preliminary study on applying holistic health care model on medical education behavioral intention: a theoretical perspective of planned behavior.

BACKGROUND: This study aimed to apply the theory of planned behavior to identify the medical education behavioral intention of holistic healthcare on teachers and students who influence the medical and healthcare profession, as a revised future direction for hospitals to continue to implement holistic healthcare. METHODS: This cross-sectional study was performed from April to May 2020. A questionnaire survey was conducted with the clinical teachers and students of the medical and healthcare profession in an individual Taiwan hospital as study subjects, based on judgmental sampling, and the study tool was a structured questionnaire. RESULTS: A total of 360 valid samples were collected, 105 clinical teachers (29.2%) and 255 students (70.8%). Demographic variables were significantly different between clinical teachers (mean = 3.91) and students (mean = 3.73) (p = 0.023). Post hoc analysis regarding work experience found that those with work experience < 2 years (mean = 3.94) had higher results than those with 6-10 years (mean = 3.61) (p = 0.019). The results of multiple regression analysis indicate that the factors affecting medical education behavioral intention are subjective norm (t = 3.571, p < 0.001) and perceived behavioral control (t = 11.870, p < 0.001). CONCLUSIONS: With respect to medical education behavioral intention, clinical teachers and students are affected by the subjective norm and perceived behavioral control. It is recommended that, in the curriculum of holistic medical education, designing holistic medical education teaching templates and check forms can encourage clinical teachers to re-examine their beliefs in teaching, learning, and knowledge. The results of this study allow the advocator to consider from a broader view making policies of and promoting the platform of holistic healthcare on medical education. It is recommended that future researchers conduct research, investigation, and analysis on other stakeholders.

Holistic health risk assessment in an artisanal mercury mining region in Mexico.

Mexico is one of the world's leading mercury producers and exporters. However, mercury mining is carried out using artisanal procedures, which highly impact ecosystems. In the municipality of Pinal de Amoles, Queretaro, Mexico, artisanal mercury mining (AMM) is practiced in a region that has been categorized as a Biosphere Reserve. Therefore, a holistic health risk assessment for mercury was performed in the region, including environmental monitoring (air, water, and soil) and mercury exposure in both humans (children, women, and miners) and biota (plants, rodents, and worms). The atmospheric mercury determination was carried out using the JEROME® J405 analyzer, whereas total mercury in environmental and biological samples was determined by atomic absorption spectrophotometry/cold vapor. Results showed that mercury concentrations in the environmental and biological matrices exceeded their respective reference values. These results demonstrate the direct influence of AMM in the increasing levels of mercury in all the components of the studied ecosystem. Therefore, comprehensive intervention strategies must be implemented to reduce and prevent human health and ecological risks due to the presence of mercury. In this regard, the Minamata Convention for mercury control should include biomonitoring programs not only for humans but also for critical ecological receptors in polluted ecosystems.

The health imaginary of postural yoga.

This paper explores the capacity of yoga narratives and practices to contribute to and relate ideas about health. It adds theoretically to existing literature on yoga by introducing the concept of the 'health imaginary' as an analytic lens for considering yoga discourses in late modern times, where personal health care and spiritual ambitions are once again becoming blurred. With this perspective, the paper provides a thorough analysis of how yoga postures (asanas) are conceived to work therapeutically, in yoga's recent history and in present-day yoga therapy. Taking case studies from India and Germany, it is shown empirically how the application of asanas is rationalized differently in specific geographical and therapeutic environments - particularly regarding the presumed theory of the body. Thus, the concept of the health imaginary not only provides analytic space to explore the implicit logics and goals of healing in different contexts, but also offers clues about the distinct social, cultural/religious, and local influences that draw people into yoga and contribute to its selective appropriation across the globe.